Women and Blacks Fare Worse After Heart Attacks

Disparities in care may be one reason for the differences

Women and blacks lose more years from their expected life spans to heart attacks than white males, according to a new study. On average, women lost 10.5 percent more of their expected life than men did, and blacks lost 6 percent more than whites.

Researchers say differences in care may be one reason for some of this disparity, though not the only reason.

“Black patients had more risk factors, were sicker when they first presented to care and received less treatment than white patients,” said Emily Bucholz, M.D., study lead author and a pediatric resident at Boston Children’s Hospital. “However, we were not able to explain the sex differences in life years lost that we observed.”

For the study, researchers analyzed nearly 147,000 Medicare patients who’d been hospitalized for a heart attack from 1994 to 1995. Forty-eight percent of the patients were female and 6 percent were black. After 17 years of follow-up, more than 7 percent of the study’s participants were still living. The survival rates were 8.3 percent for white men, 6.4 percent for white women, 5.4 percent for black men and 5.8 percent for black women. Women lost almost two more years of potential life after a heart attack compared to men, and blacks lost nearly a year more of potential life following a heart attack compared to whites.

More telling: After researchers adjusted their statistics so they wouldn’t be thrown off by factors like the level of illness in the patients, blacks gained a life span advantage over whites. This suggests blacks were sicker when they went to the hospital and weren’t given the same treatments as whites, Dr. Bucholz said.

In an accompanying commentary to the study, Jack Tu, M.D., a senior scientist at Sunnybrook Health Sciences Center in Toronto, called it “disconcerting” that the study’s results suggest whites and blacks were treated differently in the hospital, with blacks getting fewer treatments such as clot-busting drugs, bypass surgery and angioplasty.

Even with the adjusted statistics, women still lost 8 percent more of their expected life span compared to men, though Dr. Bucholz and her team aren’t sure why. She suggests that biological differences or worse follow-up care might be possible reasons.

Now that the study results, which appear in the August 11 issue of the Journal of the American College of Cardiology, have been presented, Dr. Bucholz hopes policymakers will address the issue. “Presumably, more equitable delivery of care both before and after heart attack can help address many of the racial differences in life expectancy and years of life lost after heart attack we observed,” she said. To that end, national policymakers need to focus on “reducing racial disparities in health care, but also on understanding why women are at higher risk after heart attack than men.”